When given a choice, patients faced with a terminal illness will often choose care focused on symptom management and quality of life rather than longevity. Most often this care requires administering simple medications such as opioids, avoiding invasive procedures, and dedicating clinicians’ time to ensure that symptoms are well-managed, and the broad range of concerns are addressed. At UCSF and elsewhere palliative care programs consistently demonstrate cost savings.3 As our chief operating officer says, “We support palliative care because it’s the right thing to do. It helps that it reduces costs, but that’s not why we do it.”
4) Mission alignment: Hospitalist programs align beautifully with the mission of hospitals to provide high-quality, safe patient care at lower cost and with higher satisfaction. Many hospitals have other concerns that hospitalists help with, such as increasing throughput, managing unassigned patients, and improving care processes. Similarly palliative care programs improve the quality of care for patients with life-threatening illness, reduce costs, and increase patient and family satisfaction. Palliative care services also help with throughput by helping to transition patients to less intensive levels of care consistent with their preferences and expediting discharge to home and hospice.
5) Interdisciplinary skills: No hospitalist is an island. The effective hospitalist understands the benefits and necessity of working closely with colleagues from other disciplines to provide high-quality care. In the same way it requires an interdisciplinary palliative care team to address the range of issues facing patients from pain and symptom management to depression and anxiety to spiritual concerns to practical questions about how to get help at home and who will pay for it. The skills that hospitalists develop working with colleagues in the hospital are identical to those needed to provide palliative care.
WHY HOSPITALISTS MUST GET INVOLVED
The parallels between hospitalist programs and palliative care programs support the role of hospitalists in providing palliative care. But there are other important reasons for hospitalists to become involved with palliative care teams.
First, palliative care adds variety to work. Although it may seem that any given day already has too much variety, focusing on palliative care issues, and visiting with patients about their hopes and fears can be a welcome change from general hospitalist work. Second, palliative care can provide incredible personal rewards. Third, palliative care can add diversification to a hospitalist’s income stream through professional fees and hospital support directed at palliative care. Fourth, for the vast majority of us hospitalists who are generalists, palliative care offers the opportunity to develop special expertise and even board certification. Finally, a palliative care service in the hospital can increase the status of the institution, improving family satisfaction, addressing many JCAHO requirements, and supporting the bottom line.
As hospitalists we have many ways to get involved with a palliative care service. Those who are really motivated can lead the implementation of a palliative care service. Because only a minority of hospitals have palliative care programs, this opportunity will be available at many institutions.4,5 But even if you don’t want to lead the effort, you can still play a key role by joining an existing palliative care team or joining a team that is planning to start a program.
Palliative care programs can improve the care of seriously ill and dying patients. They address an important and unmet patient care need and mesh well with the mission and goals of nearly all hospitals. Hospitalists are perfectly positioned to participate in, lead, and use palliative care services. Such work not only helps our patients but benefits us as well by providing the rewards of helping patients and families in need. In the end, we gain not only from easing the suffering of our fellow human beings but from remembering how precious life is, how limited our time is, and how important our choices are about how we spend our time. TH